Exploring the future of thrombectomy: cyclic aspiration takes center stage
Ten years ago, a forward-thinking team from the University of Pennsylvania challenged traditional methods of clot removal through aspiration thrombectomy. Led by Scott Simon, Casey Paul Grey, Trisha Massenzo, David G Simpson, and P Worth Longest, their study, titled "Exploring the efficacy of cyclic vs static aspiration in a cerebral thrombectomy model: an initial proof of concept study," investigated the potential benefits of cyclic loading in this procedure.
In current practice, aspiration pumps typically rely on static loading or static suction, using a continuous pump or syringe to apply suction through the catheter on the clot. To assess the effectiveness of cyclic aspiration, the team developed a bench-top model using the Penumbra pump, a three-way valve, and a Penumbra 5Max catheter. Synthetic clots were subjected to aspiration at different frequencies and using various mediums, recording clot removal success or failure and the time taken.
The study revealed a noteworthy trend – cyclic aspiration outperformed static aspiration in both overall clot removal and removal speed (p<0.001). Specifically, frequencies near 6.3 Hz (Max Hz) in cyclic aspiration demonstrated remarkable efficiency, clearing clots faster than counterparts at 1 Hz and 2 Hz (p<0.001 and p=0.024, respectively). Importantly, the dynamics of loading cycles, particularly pressure waveforms, played a pivotal role in influencing both speed and overall removal of the clot (p<0.001). Furthermore, the choice of aspiration medium proved significant, with water proving more effective than air for clot clearance (p=0.019).
These findings strongly support the superiority of cyclic aspiration over traditional static loading. The detailed examination of cycle frequency, pressure waveforms, and aspiration medium offers insights for optimizing existing thrombectomy technologies. This not only lays the foundation for potential procedural improvements but also hints at the potential for entirely new technologies, promising higher recanalization rates and improved patient outcomes.
This study serves as a beacon of hope for patients and practitioners alike, suggesting that the future of clot removal might lie in cyclic aspiration. This innovation has the potential to redefine the landscape of ischemic stroke intervention, ushering in a new wave of possibilities for improved outcomes.
FREQUENTLY ASKED QUESTIONS, ANSWERED:
How does cyclic aspiration differ from static loading in thrombectomy, and what advantages does it offer?
Cyclic aspiration involves a dynamic, oscillating suction approach compared to the static loading used today. The study reveals that cyclic aspiration outperforms static loading in both overall clot removal and removal speed. Specifically, frequencies near 6.3 Hz demonstrated remarkable efficiency, clearing clots faster than their static counterparts at 1 Hz and 2 Hz.
What role do pressure waveforms play in the efficacy of cyclic aspiration, and how can this knowledge impact thrombectomy procedures?
The study highlights the crucial influence of pressure waveforms in the dynamics of loading cycles during cyclic aspiration. These waveforms significantly affect both the speed and overall clearance of synthetic clots. This insight provides valuable information for optimizing existing thrombectomy technologies, potentially leading to procedural improvements and increased efficiency.
How might the findings of this study impact the development of future thrombectomy technologies, and what potential advancements could be on the horizon?
The study suggests that the superiority of cyclic aspiration over static loading provides a foundation for potential advancements in thrombectomy technologies. Understanding the detailed nuances of cycle frequency & pressure waveforms opens the door to the development of new technologies that may yield higher first pass recanalization rates and improved outcomes.
Citation: Simon S, Grey CP, Massenzo T, et al Exploring the efficacy of cyclic vs static aspiration in a cerebral thrombectomy model: an initial proof of concept study Journal of NeuroInterventional Surgery 2014;6:677-683.
